Artificial intelligence weights the importance of factors predicting complete cytoreduction at secondary cytoreductive surgery for recurrent ovarian cancer

Giorgio Bogani,Diego Rossetti,Antonino Ditto,Fabio Martinelli,Valentina Chiappa,Lavinia Mosca,Umberto Leone Roberti Maggiore,Stefano Ferla,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5

Objective: Accumulating evidence support that complete cytoreduction (CC) at the time of secondary cytoreductive surgery (SCS) improves survival in patients affected by recurrent ovarian cancer (ROC). Here, we aimed to determine whether artificial intelligence (AI) might be useful in weighting the importance of clinical variables predicting CC and survival. Methods: This is a retrospective study evaluating 194 patients having SCS for ROC. Using artificial neuronal network (ANN) analysis was estimated the importance of different variables, used in predicting CC and survival. ANN simulates a biological neuronal system. Like neurons, ANN acquires knowledge through a learning-phase process and allows weighting the importance of covariates, thus establishing how much a variable influences a multifactor phenomenon. Results: Overall, 82.9% of patients had CC at the time of SCS. Using ANN, we observed that the 3 main factors driving the ability of achieve CC included: disease-free interval (DFI) (importance: 0.231), retroperitoneal recurrence (importance: 0.178), residual disease at primary surgical treatment (importance: 0.138), and International Federation of Gynecology and Obstetrics (FIGO) stage at presentation (importance: 0.088). Looking at connections between different covariates and overall survival (OS), we observed that DFI is the most important variable influencing OS (importance: 0.306). Other important variables included: CC (importance: 0.217), and FIGO stage at presentation (importance: 0.100). Conclusion: According to our results, DFI should be considered as the most important factor predicting both CC and OS. Further studies are needed to estimate the clinical utility of AI in providing help in decision making process.

Sentinel node mapping in endometrial cancer

Giorgio Bogani,Andrea Giannini,Enrico Vizza,Francesco Raspagliesi,Violante Di Donato 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.1

Nodal status is one of the most important prognostic factors for patients with apparentearly stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer iscontroversial. Nodal status provides useful prognostic data, and allows to tailor the needof postoperative treatments. However, two independent randomized trials showed thatthe execution of (pelvic) lymphadenectomy increases the risk of having surger y-relatedcomplication without improving patients’ outcomes. Sentinel node mapping aims toachieve data regarding nodal status without increasing morbidity. Sentinel node mappingis the removal of first (clinically negative) lymph nodes draining the uterus. Several studiessuggested that sentinel node mapping is not inferior to lymphadenectomy in identif yingpatients with nodal disease. More importantly, thorough ultrastaging sentinel node mappingallows the detection of low volume disease (micrometastases and isolated tumor cells), thatare not always detectable via conventional pathological examination. Therefore, the adoptionof sentinel node mapping guarantees a higher identification of patients with nodal diseasethan lymphadenectomy. Further evidence is needed to assess the value of various adjuvantstrategies in patients with low volume disease and to tailor those treatments also on the basisof the molecular and genomic characterization of endometrial tumors.

A critical assessment on the role of sentinel node mapping in endometrial cancer

Giorgio Bogani,Antonino Ditto,Fabio Martinelli,Mauro Signorelli,Stefania Perotto,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4

Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.

Impact of COVID-19 in gynecologic oncology: a Nationwide Italian Survey of the SIGO and MITO groups

Giorgio Bogani,Giovanni Apolone,Antonino Ditto,Giovanni Scambia,Pierluigi Benedetti Panici,Roberto Angioli,Sandro Pignata,Stefano Greggi,Paolo Scollo,Mezzanzanica Delia,Massimo Franchi,Fabio Martinell 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6

Objective: Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changesin cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), andthe Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO)promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity ofgynecologist oncologists and to assess the implementation of containment measures againstCOVID-19 diffusion. Methods: The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020,and was closed on April 20, 2020. Results: Overall, 604 participants completed the questionnaire with a response-rate of70%. The results of this survey suggest that gynecologic oncology units had set a proactiveapproach to COVID-19 outbreak. Triage methods were adopted in order to minimizein-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concernedabout COVID-19 outbreak. Although 73% of the participants stated that COVID-19 hasnot significantly modified their everyday practice, 21% declared a decrease of the use oflaparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adoptedspecific protection against COVID-19. Additionally, responders suggested to delay cancertreatment (10%–15%), and to perform less radical surgical procedures (20%–25%) duringCOVID-19 pandemic. Conclusions: National guidelines should be implemented to further promote the safety ofpatients and health care providers. International cooperation is of paramount importance,as heavily affected nations can serve as an example to find out ways to safely preserve clinicalactivity during the COVID-19 outbreak.

Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women

Giorgio Bogani,Ciro Pinelli,Valentina Chiappa,Fabio Martinelli,Salvatore Lopez,Antonino Ditto,Francesco Raspagliesi 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: This study aimed to identify predictors of recurrence/persistence of cervicalintraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization. Methods: Retrospective analysis involving all consecutive women having conization for CIN2+between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models. Results: Data of 3,212 women were retrospectively identified. After a mean follow-up of 47(±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between priorconization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis,presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis,hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66–6.95) for HPV16/18 and HR=2.59(95% CI=1.21–5.55) for HPV types other than 16/18, positive margins at primary conization,HR=4.11 (95% CI=2.04–8.26) and HPV persistence after conization, HR=16.69 (95%CI=8.20–33.9), correlated with r-CIN2+, independently. Considering age-specific HPV typesdistribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population(>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test). Conclusion: HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18has a detrimental effect in young women, thus highlighting the need of implementingvaccination against HPV in this population. Further prospective studies are warranted fortailoring clinical decision-making for post-conization follow-up on the basis of risk factors.

Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia

Giorgio Bogani,Antonino Ditto,Stefano Ferla,Biagio Paolini,Claudia Lombardo,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2

Objective: We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. Methods: Data of consecutive women diagnosed with recurrent high-grade vaginal intraepithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models. Results: Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range, 5–42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028). Conclusion: Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes.

The detrimental effect of adopting interval debulking surgery in advanced stage low-grade serous ovarian cancer

Giorgio Bogani,Umberto Leone Roberti Maggiore,Biagio Paolini,Antonino Diito,Fabio Martinelli,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objective: To examine outcomes of patients having treatments for newly diagnosed advanced stage low-grade serous ovarian cancer (LGSC). Methods: We conducted a retrospective case series of women affected by advanced stage (stage IIIB or more) LGSC undergoing surgery in a single oncologic center between January 2000 and December 2017. Survival outcomes were assessed using Kaplan-Meier and Cox models. Results: Data of 72 patients were retrieved. Primary cytoreductive surgery was attempted in 68 (94.4%) patients: 19 (27.9%) had residual disease (RD) >1 cm after primary surgery. Interval debulking surgery (IDS) was attempted in 15 of these 19 (78.9%) patients and the remaining 4 patients having not primary debulking surgery. Twelve out of 19 (63.1%) patients having IDS had RD. After a mean (±standard deviation) follow-up was 61.6 (±37.2) months, 50 (69.4%) and 22 (30.5%) patients recurred and died of disease, respectively. Via multivariate analysis, non-optimal cytoreduction (hazard ratio [HR]=2.79; 95% confidence interval [CI]=1.16–6.70; p=0.021) and International Federation of Obstetrics and Gynecologists (FIGO) stage IV (HR=3.15; 95% CI=1.29–7.66; p=0.011) were associated with worse disease-free survival. Via multivariate analysis, absence of significant comorbidities (HR=0.56; 95% CI=0.29–1.10; p=0.093) and primary instead of IDS (HR=2.95; 95% CI=1.12–7.74; p=0.027) were independently associated with an improved overall survival. Conclusion: LGSC is at high risk of early recurrence. However, owing to the indolent nature of the disease, the majority of patients are long-term survivors. Further prospective studies and innovative treatment modalities are warranted to improve patients care.

Lynch syndrome – Muir-Torre variant: implication in gynecologic oncology

Giorgio Bogani,Umberto Leone Roberti Maggiore,Francesco Raspagliesi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5

.

Gynecologic oncology at the time of COVID-19 outbreak

Giorgio Bogani,Claudia Brusadelli,Rocco Guerrisi,Salvatore Lopez,Mauro Signorelli,Antonino Ditto,Francesco Raspagliesi 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.4

The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirusdisease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens tocurtail patient access to evidence-based treatment. Medicine is changing, basically due tothe limited available resources. In the field of gynecologic oncology, we have to re-designour treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is toachieve the maximum benefit from less demanding procedures. Extensive procedures shouldbe avoided, in order to reduce hospitalization and postoperative events that might increasethe in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopicprocedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assistedand isobaric procedures would be preferred over laparoscopy. A fair allocation of resources isparamount adequate treatments.

Morcellation of apparent benign uterine myoma: assessing risk to benefit ratio

Giorgio Bogani,Valentina Chiappa,Antonino Ditto,Fabio Martinelli,Mauro Signorelli,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.4